Search the Community

I've been taking Pristiq 100mg (plus 5mg Somit to sleep and 100mg Activigil to wake up) for the past 3 years more or less. I've been trying to quit Pristiq for many months due to HORRIBLE withdrawals whenever I forgot even one pill. I got to down the dose to Pristiq 50mg after enduring two weeks of those horrible withrawals and then they were gone, luckily. Now I'm trying to figure out my next step. There's no Pristiq 25mg where I am from. My psych told me to switch to venlafaxine 75mg three days ago, not the XR, the regular. It has such a short half life that I'm having horrible symptoms as well, even though I'm taking 37,5mg in the morning and 37,5mg in the afternoon. I'm trying to figure out if this is the best way to quit Pristiq. She says I should stay with venlafaxine and taper down from it. I'm worried about feeling awful. I can't function. Should I stay with the venlafaxine or switch back to Pristiq 50mg and figure out something else? Should I bridge with Prozac form Pristiq? Should I stay with venlafaxine and THEN bridge with Prozac? Should I just taper down from venlafaxine? By the way, thank you all for describing so accurately all the discontinuations sympotms of the Pristq- the brain zaps, the headaches, the dizziness, the confusion. What has this done to us? I want out.

Hi everyone, I am new to this site and am glad to have found it. Twelve years ago when I was 14 years old I was put onto Cipralex 20 mg once a day. I have been on that medication since until last month when I officially tapered off and my doctor put me on Wellbutrin XL 150 mg once a day. It has not been until recently that I’ve read about lasting permanent effects on personality, mood, and behaviour from being on antidepressants for so long. Especially for someone such as myself who was on it from 14 years old to 26 years old while my brain was developing. I am beyond concerned with what this may have done to me and feel helpless and unsure of what to do or where to go from here. I’m not even sure where to begin to look on this site. I have felt “monotone,” blank and emotionless for the past probably 4-5 years, which was one of the reasons I wanted to discontinue Cipralex. It’s like I can no longer feel any range of emotion. I cannot remember the last time I felt genuinely happy or genuinely sad. I used to be so energetic, bubbly, outgoing, and silly, I could light up a room and now it’s like that part of myself is gone—extinguished or muffled. I can feel nothing other than “flat” every single day. There are no ups or downs, so it’s not just anhedonia but I can’t feel sadness or anger either. I believe this is sometimes called emotional blunting? I’m wondering if this will ever go away and if I will ever feel like I did when I was 14-18 again. This emotional numbness feels like a death sentence. When I research online it says emotional blunting should be reversed once off of SSRIs but I am concerned maybe that will not be the case for me seeing as though I was on the medication for 10+ years and during critical brain development. I guess I can feel some sadness because thinking about being emotionally blunted forever makes me want to cry. I long to feel strongly about anything again. I would love to hear other’s stories about coming off of Cipralex/Lexapro/Escitalopram after 10+ years during peak developmental brain years and their experiences with managing this emotional numbness and if any sense of normalcy ever returned to them. Ideally I would like to eventually come off of Wellbutrin too. After being on Cipralex for so long and experiencing the side effects I had while on it, I’m concerned about being on any antidepressants now.

Hi everyone. I'm 22, queer, and graduating college in a few months. I actually discovered this website fairly late (much to my chagrin). Wish I knew about this sooner. Anyway, I knew I wasn't mentally stable since before the pandemic. I had a feeling it was because of my childhood. I thought it was normal but when you compare your childhood with your friends it definitely wasn't normal. I thought being verbally and physically abused by your mother was normal. Until I started feeling the side effects of depression in college. I was irritatable, often felt sad for no reason, and I didn't have the motivation to do anything. I even had a hard time completing my assignments for class. Then the pandemic came, and it was even harder for me because I was stuck in the same house as my abuser (In asian households we dont move out). I started talking to my college guidance counselor and she really helped. But it wasn't enough, she directed me to a psychiatrist. And in 2020, thats when I was diagnosed with major depressive disorder (I mean, I already had a feeling I just didn't want to diagnose myself). My psychiatrist prescribed me sertraline (50 mg). It was gradually building up to it, so I took half a pill first for every other days then after a few months I took the whole pill. Been taking the whole pill for nearly 3 years. It was only until last year my psych started slowly tapering me off over the months. Taking a pill every other day and then half a pill eventually. I was doing so well, I never experienced any side effects from the tapering. March 28, 2023 came and my psych said I'm ready to stop my antidepressants. So I did, and I didnt feel any withdrawal symptoms until after a month. April 23 I started feeling dizzy on some days, it was never consistent. I asked my psych about it but she said it was "impossible" because its "been a month." I didnt believe her. I looked for communities that could help me and I found the r/antidepressant in reddit. They validated my symptoms and pointed out it was delayed withdrawals or a discontinuation syndrome. Over the months until now I started noticing my withdrawal symptoms. It was a russian roulette of feeling dizzy, lethargic, not wanting to socialize, not wanting to eat, not wanting to do anything, wanting to cry for no reason, heart palpitations, or feeling sad for no reason. These symptoms are never consistent it lasts for a few hours then I'm fine again. I just wish it would go away soon, I want to feel normal again.

Change is coming 😁 https://www.psychologytoday.com/us/blog/psychiatry-through-the-looking-glass/202010/withdrawal-antidepressants-review

Change is coming 😁 https://www.madinamerica.com/2020/10/reckoning-antidepressant-withdrawal/

Hello everyone! I am a new user here. I've lurked around this site before but have yet to introduce myself. I was a Prozac user for a year from August 2015 - September 2016. I had taken it for social and general anxiety. I was on 20mg/day. Initially, I was actually doing fine and great emotionally but had side effects like massive fatigue everyday (not even 3 cups of coffee could wake me up!) and constipation every time I went to poop (sorry for TMI). I also felt like a zombie for a brief period in which I was neither happy nor sad. In May 2016, I decided to abruptly stop taking the Prozac by choice without consulting my doctor (bad move!) and had brain zaps and mood swings which I assumed as worsening depression. I then just asked my doctor to simply increase my dose because I thought I was getting worse (bad move again!). I was put on 40mg/day from June - August 2016 in which I was ok at first but then I was hit with a panic attack so severe I had to rush to the ER. For that week, I was having very severe symptoms. So I was instructed to go back down to 20mg/day. From then on, I decided to stop taking it a few months ago in September because I felt better and didn't want to rely on medication anymore to make me happy. I consulted with my psychiatrist who said for me to just take 10mg for one month and then I can stop. I did just that. Over the month of October I was fine and felt completely normal. However, I realized symptoms would come later once the month of November started. I have since felt every type of symptom under the sun including brain zaps, hot flushes, insomnia, irritability, tingling sensation of the skin, anxiety, shortness of breath, sweating, tremors, and slight vertigo. I have never felt these symptoms in my life til now! I've talked to my doctor and he doesn't believe in withdrawals. At this point I feel helpless. I am experiencing waves and windows in which I have waves of really bad flare ups and then windows of good normal days where I feel fine. But they keep cycling back and forth. I now have questions to ask: 1. Do windows of no symptoms mean that my body is getting better? 2. Should I reinstate the Prozac and taper off more gradually? Someone suggested I shouldn't because I've already been clean for 3 months now. But what do you guys think? 3. Will symptoms go away if I keep pushing cold turkey? 4. Should I try medical weed to help ease tthe symptoms? I want to try natural ways of healing

Has anyone out there had hypoglycemia when trying to taper off their SSRI? I’m just now starting to understand that many of the odd Sx I am having are likely related to this. My PCP has been flummoxed. I was having night sweats, crazy dreams, sever dizziness, fatigue, couldn’t think. Also, had the “brain zaps” that I could never figure out how to describe until I found articles on my own. In an effort to to try to figure out what was happening, I started wearing a continuous blood glucose monitor and found my CBG’s were dropping into the 30’s at night. This resolved when I started taking my Prozac again. However at the time I had just started taking some new supplements and I attributed it to that. I can’t afford to get another monitor to further test this, I had signed up for a free trial, they are super expensive. None of my lab work is indicative of diabetes, and we’ve checked everything. Thanks all for you input.

I had been on Effexor 37.5 was varying doses for approximately 7 years. As of the beginning of 2022 I started having really strange symptoms such as hot flashes sweating insomnia racing heart and general feeling of being unwell. June fourth I had only slept about 4 hours for a few days each and decided to go to the ER to rule out anything physical. When I told them if I don't sleep I want to drive my car off a cliff they kept me. So I stayed 3 days with no medication. Initially I started to feel well. Clear minded and actually could feel Joy. No it's July 4th and it's getting worse if that's even possible. My symptoms are becoming intolerable so I decided to take 5 mg of Fluoxetine. This was about an hour ago. I feel like I'm in a dream I have no energy it's hard to even walk and my heart is racing I can literally hear it pounding in my ears and all I want to do is cry and go to the hospital. But I don't know if they treat this there discontinuation syndrome. I don't know what to do please help

Dear community, I was recommended this forum after seeking advice for my current situation on Reddit. The last four month have been the hardest so far in my life. I took Przac for about 10,5 years (from when I was 16 to when I was 27 years old) until I stopped taking it in December 2020. At that point I was on 10 mg Prozac for about a year (20 mg previously) and my psychologist encouraged me to try stopping it for good. It was my wish to stop too as I had develop restless-leg-syndrome over the past yars and suspected it might be connected to Prozac. I took Prozac for my anxiety, depression and obsessive-compulsive thinking. I stopped taking Prozac on christmas eve 2021. I didnt taper as 10 mg is already the lowest dose in my country and my therapist didnt think it was necessary. For two weeks I was fine, then the former emntioned symptomes came back with a force I did not expect. My biggest fear is becoming psycotic (which I never have so far) but this fear together with cpompulsive thought, constant panic attacks and depression consumed me. After just 3 weeks I decided to take Prozac again. What then happened Id have never expected: My body just wasnt having it anymore, I got more and more nauses every day I took Prozac (10 mg) and after 2 weeks I had to stop because I was puking almost every day. I then didnt take Prozac for 4,5 weeks. By then I was close to getting myself hospitalized: The fear of getting psychotic was nonstop and compulsive and racing thoughts where torturing me all day. I had to try to take Prozac again. Immediately the nausea kicked in and after talking to my psychiatrist she perscribed me Zoloft. I tried that for just 5 or 6 days and felt so abd I stopped it and then took Prozac again. THis time the nausea was ok, I took it for 2 weeks, started to feel better, but suddenly the restless-leg-syndrome came back, I stopped taking Prozac for 3 days, then tried to take it again but started puking again and got such a bad headache I thought Id die. So I stopped again and didnt take it for 8 days now. I know I messed up. I can hardly imagine the harm I did to my body and brain by doing this stop-and-go chaos. I was writing on my thesis and had a lot of stress in my life (aside from the medication-problems). Now I feel worse than ever. I am in constant fear of getting psychotic, im neauses every day, have constant panic-attacks, my thoughts are a total chaos, random and chaotic. I dont know what to do. Will it get better? Am I getting psychotic because of what I did to my body (after 10 years of beaing afraid of this exact thing)? Should I take Prozac again, no matter the nausea and the restless-legs? I know there is probably no answere to all my questions. But I am thankfull for every word, every reply, just the idea that I am not alone in this. Thank you for taking the time and reading this. This is my Prozac journey so far: Fluoxetin (10-20 Mg): 2010 - 2020 No Med: 25.12.2020 - 17.01.2021 Fluoxetin (10Mg): 18.01.2021 - 31. 01.2021 No Med: 01.02.2021 - 06.03.2021 Fluoxetin (10 Mg): 07.03.2021 - 08.03.2021 No Med.: 09.03.2021 - 12.03.2021 Sertralin (12,5 Mg): 13.03.2021 - 15.03.2021 Sertralin (25 Mg): 16.03.2021 - 17.03.2021 Fluoxetin (10 Mg): 20.03.2021 – 08.04.2021 No Med: 09.04.2021 – 11.94.2021 Fluoxetin: 12.04.2021 – 14.04.2021 No Med: Since 15.04.2021

Hello, my name is Danielle. I am new to this site, but have been reading it for quite some time now. My parents put me on effexor xr when I was 6 years old for severe anxiety and childhood phobias. It worked great for years. I had very little side effects and life was hunky dory. I am now 24 years old and the medication is no longer working. I stupidly tried to come off of the Effexor over the coarse of 3 months under directions from my psychiatrist. Obviously, I crashed and I have been desperately trying to get my life back for the last 10 months. During those months, I was under the impression that I was ‘very ill’ and a ‘special case’ based on the severity of my symptoms, but now I am realizing what has happened to me is not my original illness resurfacing, but the effects of the discontinuation of the medication. I’m an RN and have been out of work for the last 6 months. I have read stories on here of people eventually recovering from ssri and snri withdrawl, but was wondering if anyone has any experience or knows of anyone who was prescribed one of these drugs as a child. Is there hope for me or will I have to live with the consequences of my parents decision for the rest of my life? Will these dehabilitating symptoms ever go away or are my receptors f***ed for life?

Hey all my story after a long period of stress I kinda started feeling strange so went to gp who prescribed me 20 mg of citalopram after 7 weeks I went back and said I don't think there are for me not knowing much about the whole ssri situation what I were feeling was apparently my brain protecting me , he suggested i tried fluoxetine so I did another 2 months off and another cold turkey ...,, Back to docs not knowing that I was suffering due to the damage the drugs had done so bring story forward after sertraline 50 mg for a few months which absolutely destroyed me I tried Paxil as I genuinely believed I was depressed I didn't know such a thing about withdrawal stayed on them for about 2-3 months I am know 7 months without anything and I genuinely feel like these drugs have destroyed my brain after all the zaps and muscle tension goin I got severe brain fog which lifted then depression which lifted then anger now im stuck with a constant feeling of depersonalisation last few days started really weird dreams and sleep disturbances even though I'm on holiday I am sitting by a pool then boom out of nowhere really bad anxiety I never had these before I tried those stupid drugs I have tried vitamins and supplements but I now can't handle any stimulant I used to go to the pub regularly but know I can't even hold s drink without getting sort of naggy drunk after a very small amount , caffeine is out the question also I'm a builder and need to concentrate as I work up heights my concentration and memory are terrible sorry to go on !!!lol I know each day offers different symptoms but I genuinely believe I won't be what I was before many thanks keep up the fight

All of my symptoms in bolded, for ease of quick scanning for relevance by anyone interested. I have ended up on this website after lots and lots of google research to pin down the cause of my incessant symptoms of a low-grade migraine headache and constant nausea that I have been experiencing for 10 days straight now. My Migraine History: I have been getting migraines fairly regularly (about 2 or 3 each month) since middle school. but they are pretty mild, as migraines go. About 25% of the time, one will be preceded by an aura that is a lightening-shaped blind spot or blurry vision and then the headache will be very severe. And occasionally, one will be accompanied by severe nausea. But normally, my migraines are just quite painful headaches accompanied by heightened sensitivity to light, sounds, and smells. With ibuprofen and extra sleep, they are usually completely gone within 30 hours. During puberty and especially pregnancy, my migraines were more severe in all aspects: nausea, sensory sensitivity, and pain. My Venlafaxine Withdrawal/Discontinuation Symptoms: I did not connect these symptoms to the cessation of Venlafaxine until recently because 1. I did not know that physical symptoms could be related to the cessation of antidepressants. 2. The onset of symptoms did not occur until 5 days after my last half dose of Venlafaxine. 3. I was only on Venlafaxine for 27 days (including a half-dose for the last 7 days). I only made this correlation after several days of googling possible causes, and after including symptoms that I had previously dismissed as insignificant and inconsequential in my internet searches I started experiencing a persistent nausea that did not seem like food poisoning or stomach flu (no stomach cramping, etc.) 14 days ago. There were/are waves when the nausea is worse throughout the day, and a constant malaise otherwise. Unlike the stomach "flu" or food poisoning, there is/was no stomach cramping or urge to vomit. On the 4th day of no relief, I realized that it was just like the nausea I get that sometimes accompanies my migraines. I hadn't equated it with a migraine previously, because there was no headache. I started taking ibuprofen periodically, treating it as if it were a migraine. On about the 5th day, I could feel a headache "trying to set in", which is my usual precursor to an impending migraine (although historically the nausea, if it develops, does not come on until after the headache presents). Since then, I have had no improvement in symptoms. On about day 6, I started googling possible migraine prescriptions and was considering seeing my M.D. the following day, if there was no improvement. I also started googling the combination of all my other mild/querky symptoms to see what else it could possibly be, if not a migraine. These other sporadic symptoms had each seemed inconsequential as they had come and gone here and there, and were easily dismissed. But I was starting to realize they might be related. Muscle Weakness in my biceps that I had noticed when using a steering wheel or when filing through clothing racks while shopping. Crying and/or the feeling that I needed a good cry, without provocation, that felt very similar to PMS (although this was about 10 days after my last menses). Brain Fog in the middle of conversation. I will have to concentrate really hard to remember what the conversation is about, and what I was going to say next. I will forget what my husband told me just minutes ago. Word Recall Difficulty both while texting/typing (spelling) and in conversation (vocabulary). High Pulse Rate of 88pm, which was noted at the medical appointment that I had on the fourth day after my last dose of Venlafaxine, when I felt great. Chills Hot Flashes/Feeling Flushed Sinus Congestion which was present before, but is now much worse, especially at night. Nausea that feels like "Morning" Sickness when there is 0% that I am pregnant. Yes, 0%. At times, I can tell that I will feel better if I eat, and at other times I can tell that eating will make me feel worse. My best time of day is the first 3-4 hours after waking up. Shivers not related to body temperature this one I just experienced last night, and suspect (hope!) is more likely related to my inadverdently taking 2 different antihistamines (diphenhydramine and cetrizine) at the same time! Very pronounced and fast onset of "prune skin" on the soles of my feet, followed by Extreme itchiness on the soles of my feet Another really bizarre symptom that I think might have another cause. ??? I had sprayed the soles of my feet at bedtime with magnesium oil two nights in a row, as I have done in the past when experiencing a severe migraine. I did not bathe or shower until a third night. 5 minutes into my bath, my feet (and only my feet) were EXTREMELY pruny, as if I had been soaking for more than an hour! I have found nothing online indicating that this wierd fluke may be related to the magnesium oil, nor to antidepressant withdrawal/discontinuation. After the bath, my feet were excruciatingly itchy (just the skin, not the nerves) for at least 30 minutes! After much reading on this and other similar forums, I contacted my P.A. that has been assisting in my medication management for the last 3 months. I am going to reintroduce 5 beads of Venlfaxine tonight and see if it makes a difference by the time my afternoon appointment rolls around tomorrow. She is doubtful that any of these symptoms are related to the antidepressant, so I hope this works. I really hope that my experience, along with the litany of literature I will be leaving with her tomorrow, convinces her of this very real and very under-reported issue!

Hey there. This is my first post, but I have a success story that I’d like to share. I’d like to preface by saying I had been on 75mg of sertraline (Zoloft) for approximately 7 months. I quit last year and have successfully made it through the withdrawals! I see more horror stories than success stories on SSRI discontinuation. My hypothesis for this discrepancy is that people who successfully quit the drug don’t really have that much of an incentive to post their stories, while people dealing with the terrible side effects are more likely to seek out information. I knew there were millions of people on SSRIs, and I refused to believe that my discontinuation symptoms would be permanent. Of course, there are always exceptions, but I found out quickly how unhealthy it was to hold this mentality of permanence. I tapered off a too quickly (~2 weeks). I believed that since I had only been on the medication for a few months, I could get away with tapering off at that rate. Consequently, I ended up having over 6 weeks of hellish withdrawals. The first 2 weeks had the most powerful physical symptoms: brain zaps, fatigue, nausea, etc. These symptoms seemed to go away around week 3, but then came another wave of symptoms: anxiety, paranoia, depression, and a lot of overthinking. I didn’t realize it till week 5, but these feelings were more powerful than when I had them before starting sertraline. Week 5 was the worst; all these terrible feelings went into overdrive. I remember a few specific days of this week were particularly dreadful. I had been reading up on SSRI discontinuation online and freaking myself out reading people’s horror stories. I was afraid that I permanently removed what it was to be human. I was terrified I’d never feel joy, sexual desire, or ambition in my life ever again. I was angry at myself that my choice to try anti-depressants fucked up the rest of my life. I was broken, and I just wanted to be normal again. These are unhealthy thoughts, and I was wrong. My life did start coming back. I slowly felt what it was like to be “me” again. Small steps every day reminded me. One day something would make me laugh. Another day I’d notice a cute girl. I appreciated and cherished every step throughout the way. And slowly but surely, old joys started coming back to me: I started feeling ambition, I was looking forward to future plans, I was dreaming again (I could sleep well again!), and I was feeling love again, both for myself and others. I believe there is a strong psychosomatic component during these withdrawals. It’s difficult because your brain doesn’t allow you get past these negative thoughts while its readjusting, but you have to keep moving. There isn’t a quick solution, but your brain is powerful and adjusts to your current circumstances. That’s why exercise, a healthy diet, a support network, and a positive outlook are so important; you want your brain to re-adjust in an ideal setting. So, don’t blame yourself or hold a grudge for trying SSRIs; you actively did something to confront your inner demons. From one stranger to another, you will survive this. Good luck.

After close to 18 months on Citalopram, I decided to wean off the medication in August as I ascribed a feeling of mental numbness to the drug. The first week off I felt fine. Weeks 2-4 were hellish as I experienced strange tingling sensations, insomnia, depersonalisation and extreme periods of agitation. However, after close to six weeks off the drug, I still don’t feel like myself. I’m apathetic. My concentration is non-existent despite taking medication for ADHD. My brain is extremely foggy, and I don’t feel connnected to myself or those around me. Whilst I didn’t quite adhere to my discontinuation plan and admittedly weaned off Citalopram far too quickly, I didn’t expect to feel so utterly lost in myself after almost six weeks off the med. My doctor is in the process of conferring with a psychologist with regards to taking a different medication for anxiety but I’m reluctant to go back on an SSRI. Unfortunately I don’t know if I’m still struggling with SSRI withdrawal syndrome or if it’s a resurfacing of depression and/or a high level of anxiety. I’d be interested to know if anyone else has experienced similar difficulties after discontinuing an anti-depressant and what helped you in your respective recoveries. Thanks.

Am J Psychiatry. 2017 May 1;174(5):485. doi: 10.1176/appi.ajp.2017.16101158. Citalopram Discontinuation More Harmful Than Gradual Dosage Reduction? Krijnsen PJC1, van Os TWDP1, Wunderink L1. Abstract at https://www.ncbi.nlm.nih.gov/pubmed/28457157 KEYWORDS: Antidepressants; Cardiology; Citalopram; Long QT Syndrome; QT/QTc Prolongation; Serotonin Reuptake Inhibitors; Torsades de Pointes Comment in Clarifying Methods in a Study of Outcomes of Citalopram Dosage Risk Mitigation in a Veteran Population: Response to Krijnsen et al. [Am J Psychiatry. 2017] Comment on Outcomes of Citalopram Dosage Risk Mitigation in a Veteran Population. [Am J Psychiatry. 2016] This is a comment on Rector, 2016 Outcomes of Citalopram Dosage Risk Mitigation in a Veteran Population. (full text) Article requested from Dr. Wunderink.

I have been on 40 mg. fluoxetine for past 5 years as treatment for Major Depression and Social Anxiety. June 2016 I began a slow tapering using liquid solution of fluoxetine. Additionally I reduced my nightly dose of Imiprimine and I am successful and holding at 10mg. Dec. 4 2016 I took 16.8mg=4.2ml of the liquid fluoxetine. Dec. 5 I made the decision since I was at such a low dose I could stop. All was well until Dec. 17, at 13 days of no dose, my stomach began having painful cramping, bloating, gas, cold sweats, faint feeling, nausea, fatigue, husband says maybe a stomach bug? Pain and bloating went away on Dec. 21 but nausea and fatigue still with me as of today 12/24. Could this be a virus or very likely discontinuation? I am tempted to try a small dose of Fluoxetine to get some kind of normal back for a few weeks. ​Any help or suggestions greatly appreciated. I would like to get better quickly to enjoy the holidays.

My Comment: This is the complete letter. The references can be seen via the link. I was interested in what they say about the mechanism, at the end. AFAIK, atomoxetine is an SNRI. It gave me the most horrendous evil feeling in the muscles of my legs that I went to emergency after a few days and almost got locked up. It wasn't pain per se. It was like "expectancy." These novel drugs give us sensations we can't describe, so the doctors describe us as crazy, you know? Prim Care Companion CNS Disord. 2013; 15(2): PCC.12l01427. Published online 2013 Mar 21. doi: 10.4088/PCC.12l01427 A Case of Amelioration of Venlafaxine-Discontinuation “Brain Shivers” With Atomoxetine Jose A. Cortes, PhD and Rajiv Radhakrishnan, MD Full text at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3733524/ To the Editor: Antidepressant discontinuation syndrome is a common syndrome seen following abrupt termination of treatment with a serotonin reuptake inhibitor.1 It occurs at rates ranging from 17.2% to as high as 78% with venlafaxine.2,3 There is, however, little literature on “brain shivers,”4,5 a common antidepressant-discontinuation symptom described by patients taking venlafaxine, duloxetine, citalopram, and paroxetine. Much of the information comes from Internet blogs and Web sites.6–8 The symptom is described variously as “an electrical shock–like sensation in the brain,” “the sensation of the brain shivering,” “brain zaps,” “brain shocks,” “brain shivers,” “head shocks,” or “cranial zings.” The etiology of the symptom is not known, and there is no known treatment for this distressing symptom. We describe a case in which “brain shivers” occurred as part of venlafaxine discontinuation syndrome and abated with atomoxetine treatment. ["we made this man miserable for nothing"] Case report. Mr A, a 34-year-old man, presented with DSM-IV major depressive disorder (MDD) that responded well to venlafaxine (300 mg/d). He achieved remission except for seasonal exacerbations during autumn during the next 4 years. In view of a family history of bipolar disorder, it was decided to add lamotrigine and taper venlafaxine. [idiots] Mr A maintained remission on venlafaxine (37.5 mg/d) and lamotrigine (200 mg/d) without seasonal exacerbations. Mr A abruptly discontinued venlafaxine 37.5 mg/d. On the second day following discontinuation, he reported feeling an unpleasant sensation of “electricity in the head” that “felt like the brain was shaking inside the skull.” Mr A was also noticed to demonstrate emotional incontinence and complained of anhedonia, anxiety, tinnitus, headache, nausea, and increased sensitivity to noise. Since the “brain shivers” were the most distressing symptom, a trial of atomoxetine 40 mg/d was attempted based on the hypothesis that the symptom was a result of noradrenergic imbalance.9 An immediate improvement in “brain shivers” was reported within 2 or 3 hours of taking the first dose. Over the next 3 days, Mr A reported further improvement in “brain shivers” and anhedonia although emotional incontinence and increased sensitivity to noise persisted. Given the severity of other withdrawal symptoms, venlafaxine (37.5 mg/d) was reinstated and atomoxetine was stopped. All withdrawal symptoms disappeared during the next day. [chalk one up for Effexor!] The case adds to the interesting speculation about the noradrenergic imbalance as the basis of “brain shivers.”9 “Brain shivers,” conceptually related to Lhermitte’s phenomenon,10 have also been reported with the noradrenergic drug 3,4-methylenedioxy-N-methylamphetamine (MDMA). The psychotropic effects of MDMA are mediated via norepinephrine transporter11 and results in an increase in synaptic norepinephrine levels. Venlafaxine’s affinity for norepinephrine transporter (K = 2,984 nM),12 is 103-fold lower than that of atomoxetine (K = 5 nM),13 yet venlafaxine causes an increase (242%)14 in synaptic norepinephrine levels comparable to that by atomoxetine (290% ± 33%).13 Curiously, chronic treatment with venlafaxine does not reduce norepinephrine transporter binding sites.15 These facts point to the possibility that increases in synaptic norepinephrine are due to norepinephrine transporter reversal, akin to dopamine transporter reversal associated with amphetamine.16 Abrupt withdrawal of venlafaxine would hence result in paradoxical increase in synaptic norepinephrine via efflux through norepinephrine transporter channels, which is normalized by atomoxetine’s norepinephrine transporter blockade. This speculation of the noradrenergic basis of “brain shivers” warrants further study.

Hi, I'm a 22yo autistic woman with PTSD and possible bipolar disorder. I was put on Lamotrigine 100mg in 2014 in response to a "hypomanic" episode (unclear whether this was correctly diagnosed) whilst taking Venlafaxine and Mirtazapine (for severe depression). The psychiatrist I saw recently was concerned that Lamotrigine was causing cognitive side effects such as inability to remember words and told me to withdraw it by 50mg per week (i.e. take 50mg for a week, and then reduce to nothing). I reduced to 50mg on one Monday, had symptoms such as nausea, instability, dizziness, vomiting and mood swings which were pretty much as expected. The next Monday those symptoms had pretty much gone so I went ahead with reducing to 0mg as planned. Since then (5 days) I've been having more of the same, plus some escalations in my autism manifestation (shut downs/dissociation and sensory processing difficulties in particular) which is fairly standard when I'm ill or under stress. Basically I've now done online research, which I didn't do initially because reading online tends to be unnecessarily scary re discontinuation symptoms. However I'm feeling pretty grim and having now read stuff I'm thinking this was done way too quickly and I shouldn't have trusted the psychiatrist when he said to reduce by 50% a week (life lesson not to trust doctors I guess..). But now I've been off it for 5 days, I guess there's very little left in my system? So I'm not sure if I should reintroduce 25mg and then come off it more slowly or if at this point I'm better to just "grin and bear it". The discontinuation symptoms are getting better rather than worse, so perhaps the latter is the better option? I don't want to confuse my nervous system even more by coming off it then going back on it and then coming off it again..